Fever: Fevers are generally a sign of illness/infection. Your child should stay home if his/her TEMPERATURE is 100 F or above. He/she should not return to school until their temperature has been normal (97 - 99 F, or 36.1-37.2 C) for at least 24 hours without any fever-reducing medication.

Cold, Cough, Sore Throat: Most children can attend school with cold symptoms as long as they do not have a fever. If your child has a cold with a fever over 100 F or 37.8 C, he/she should be kept at home and your healthcare provider should be consulted. Your child should also stay home if they have greenish nasal discharge or cough production. A sore throat with a fever, swollen glands, headache, stomachache, or rash may indicate strep. You should consult your child's doctor for evaluation. If strep is confirmed, your child may return to school after 24 hours of antibiotics, if they feel better.

Stomachache, Vomiting, Diarrhea: A child with vomiting and/or diarrhea should be kept at home until symptoms have resolved for at least 12 hours. Your child also needs to be able to eat and drink normally before returning. Consult your doctor if you suspect dehydration.

Red Eyes: Your child should stay home if he/she has red eyes that itch and/or have a crusty discharge. Consult your doctor for evaluation of possible conjunctivitis. Your child may return to school after 24 hours of antibiotic treatment.

Rash: A rash is usually a sign of a viral illness. It also may be a reaction to medication, plants, or chemicals such as soaps or detergents. If your child has an unusual rash or it is associated with a fever, contact your doctor.

What is a concussion?
The brain is made up of soft tissue and is cushioned by blood and spinal fluid. When someone takes a blow to the head
or hits something very hard, the brain suddenly shifts inside the skull. This causes the brain to knock against the
skull’s bony surface.

A concussion is a temporary change in the way the brain works when it is suddenly moved or jarred.

A concussion may last a few moments or a person may be knocked unconscious for a couple of minutes or longer.

Every year more than 400,000 children are sent to the ER with serious brain injuries. (Car crash, playground accidents or sport related accidents)

What are the symptoms of a concussion?
Symptoms may be subtle and may not appear immediately. Symptoms can last for days, weeks or months. Two most
common ones are forgetfulness and confusion. Other immediate signs and symptoms are: headache, dizziness, ringing
in ears, nausea, vomiting, slurred speech, visual changes, feeling sluggish. Some symptoms do not appear until
hours or days later: mood or cognitive disturbances, sensitivity to light and noise, sleep disturbances.

What should be done when concussion is suspected?
Anyone suspected of having a head injury should seek medical attention. The doctor will check reflexes, pupils and
balance. A CAT scan may check for bleeding and fractures. In the case of a concussion, the brain needs time to heal.
While your brain is healing, you are much more likely to have a second concussion and should not return to sports/
activities until cleared by a physician. Remember to inform all coaches that your child has sustained a concussion.

How can a concussion be prevented?
Always use proper sports equipment, including personal equipment (helmet and mouth guard), when playing sports, bike
riding, horseback riding, skateboarding, and skiing.

Diabetes is one of the most common chronic diseases in children. In the United States 1 in every 400-600 children
has Type I diabetes. (National Diabetes Education Program)

Type 1 (Insulin Dependent) diabetes is most common in youth.Type 2 (Insulin Resistance) diabetes is most common in adults but is on the rise in youth.

“Diabetes is a chronic disease that impairs the body’s ability to use food properly. Insulin is a hormone
produced in the pancreas that is necessary for the body to convert food into energy. In people with diabetes, either
the pancreas doesn't make insulin, the body cannot use the insulin properly, or both. Without insulin, glucose (sugar)
builds up in the blood.” (American Diabetes Association)

Early detection and knowledge of the warning signs is your greatest weapon against the disease and its
complications.

Behaviors a child might exhibit in school that could indicate undiagnosed diabetes are:
Excessive urination (frequent trips to the bathroom especially in close sequence, bedwetting)
Excessive thirst (frequent trips to the water fountain)
Irritability
Lack of energy, fatigue, drowsiness
Rubs eyes, complains of difficulty seeing the board
Difficulty paying attention

Other symptoms may include: Sudden vision changes
Fruity/sweet odor to breath or urine
Increased appetite
Rapid or unexplained weight loss
Nausea, vomiting or abdominal pain
Tingling or numbness in the legs, feet or fingers
Frequent infections of the skin, cuts that are slow to heal
Darker patches of skin usually in neck folds
Itching of skin and/or genitals

Note - Many of these symptoms can be related to illnesses that are not associated with diabetes. Only a healthcare
professional can provide appropriate diagnostic tests and treatments.

Spring usually brings about a few cases of fifth disease. What is it? It is a mild childhood illness that causes a rash.
It is called “Fifth disease” because it was the fifth of a group of similar rash illnesses to be described. (Rubella, measles and scarlet fever are also in this group). It is caused by a parvovirus that lives in the nose and throat and can be spread from person to person. The virus usually
occurs in 3 stages:

The first stage consists of mild headache, body ache, sore throat, and low-grade fever. This stage lasts 2-3 days.
During this stage the virus may be spread to others. The symptoms are often very mild and may not be noticed at all.

The second stage last about a week and most children have no symptoms at all during this time.

The third stage involves a bright red rash on the cheeks, which gives a “slapped cheek” appearance. This is
followed by a “lacy” rash on the chest, back and arms. The rash may appear on and off for several weeks with changes in
temperature, sunlight, and emotional stress. The appearance of this rash is how Fifths Disease is diagnosed. By the time
the rash appears and the diagnosis is made, children are no longer contagious so there is no need to exclude them from
school. Adults may not develop the third-stage rash but may experience joint pain, particularly in the hands and feet.
The disease is usually mild, and both children and adults recover without problems. There is no specific treatment
for Fifth Disease. Health care providers may suggest treatment to relieve some symptoms. There is no vaccine to prevent
Fifth Disease. In rare situations some people, especially those with blood disorders or weakened immune systems or
women who are pregnant, may be at risk for complications and should notify their health care providers about possible
exposure to the virus. The CDC (Center for Disease Control) at
www.cdc.gov and the Massachusetts Department of
Public Health at
www.mass.gov/dph are good sources of information.

What are Head Lice?
Head lice (pediculosis) are tiny, wingless, elongated insects that are tan to grayish-white, but may take on a
reddish-brown color after feeding on their host. They are about the size of a small sesame seed, and their six
legs have claws for grasping hair. They cannot fly nor can they jump. Head lice, which have a life span of about
30 days on a host, are parasites that feed on human blood. The lice bites cause itching, which is often the first
sign of infestation. A female louse lays 100 or more eggs (“nits”), which hatch in 7-10 days. Nits are oval or
teardrop shaped, and may be colored yellowish-brown, white, or silver. They are quite tiny, about the size of the
period at the end of this sentence. Lice attach nits at an angle to the side of a hair shaft with a water-proof,
cement-like substance; therefore, nits cannot be washed or brushed out of hair like dandruff or other debris.

How are Head Lice Spread?
Head lice are spread through direct head-to-head contact. The lice do not hop, jump, or fly, so sitting near
someone with head lice will not increase the risk of getting the lice. Transmissions in schools are rare; it is
more common to get head lice from family members, overnight guests, and playmates who spend a lot of
time together. Although the spreading of lice through hats, helmets, and headphones is possible, it is rare. It
is more common for transmission to occur from pillows, hairbrushes, or bedding.

How Do I Check for Head Lice?
Because head lice move so quickly, they are difficult to see, so the diagnosis of infestation is usually made
on the basis of finding nits. Nits are barely visible to the naked eye. It can be especially difficult to see
nits in light-colored hair. It may be helpful to use a magnifying glass to search for them. It is also essential
to use a bright source of light, with natural sunlight being optimal. Comb carefully through the hair, looking
for nits. Pay close attention to the back of the head, nape of the neck, and behind the ears. Nits are most
commonly clustered in these areas, but examine the entire scalp. In rare, severe cases, nits may be found in
eyebrows and eyelashes. Nits are usually found close to the scalp, about 1/4” to 1/2” away, but they can be
found at any distance along the hair shaft, attached securely.

Can Head Lice Cause Infections?
In general, head lice do not pose a human health risk. In some severe cases, excessive scratching can cause
infections in children. These infections can cause swelling of lymph glands around the head, especially behind
the ears and on the neck.

Treatment

Treatment must be directed toward the infested person AND his/her personal articles.

ALL family members must be checked and, if found to be infested, also treated. Males as well as females
can be infested. Hair length does not matter (other than for ease of nit removal).

The environment must be cleaned.

Rechecks are essential to control infestation and reduce the possibility of re-occurrence.

Check your child’s hair and scalp WEEKLY throughout the school year. This may take up to 30-45
minutes, but it will become routine. It is much easier to treat a mild infestation than when lice
have been living on your child’s head for weeks!

What Can I Do to Avoid Rinfestation?

Check all family members whether they were infested or not during the next two to three weeks.

Remember to treat the home environment. Vacuum rugs and upholstered furniture, mattresses and
car seats as needed to remove loose hairs and nits. Clean clothing, bed linens as outlined under
treatment. Be sure to clean combs and brushes.

Where Can I Get More Information?
Your school nurse or health care provider can give you more resources about head lice. There are
helpful web sites, videos, articles and books that they can recommend and/or lend to to you.

Description - Staph are bacteria commonly carried on the skin or in the nose of healthy people. About 25-30%
of the US population carries staph on their bodies at any time. MRSA is a rare type of staph that is resistant to some
antibiotics. Severe infections with MRSA are rare and are more commonly seen in health care setting, not schools.

Transmission – Staph, including MRSA are spread by direct skin-to-skin contact. It can also be spread by
contact with items that have been touched or used by people with staph such as sharing towels, razors, and athletic
equipment. Most people who have staph or MRSA on their skin do not have infections or illness. Staph infections
including MRSA start when staph enter a cut or break in the skin.

Symptoms – Minor staph infections may cause ordinary boils, pimples and rashes, such as impetigo. Severe staph
infections are uncommon in healthy children. A sign of more serious infection could include high fever, headache,
fatigue, heat and pain around a wound. The symptoms of MRSA are the same as other staph infections.

Treatment – See your doctor if the infection is large, painful, swollen, red and does not heal by itself. Your
doctor will determine if you need antibiotics. Students with a MRSA infection can attend school as long as the wound is
covered and they are receiving proper treatment.

Reducing Risk – Practicing good hygiene is the best way to prevent getting and spreading MRSA infections. Keep
hands clean by washing them frequently with soap and warm water. Use an alcohol-based hand sanitizer gel when soap
and water are not available. Keep cuts and scrapes clean and covered with a bandage until healed.

Childhood sunburns can increase your child’s risk of developing skin cancer as an adult. Even a suntan can be harmful
to children. Tanning is an outward sign of internal skin damage. Research shows that much of the damage to skin is
done in the first 18 years of life. Protecting skin and eyes during these early years can reduce the risk of some types
of skin cancer by up to 78%. Melanoma is a cancer of younger people and can start as early as adolescence.

Youth and Skin Cancer

50% of lifetime exposure to UV light occurs during childhood and adolescence.

It can take less than 10 minutes for a child’s skin to burn.

Children with severe sunburns are at an increased risk for skin cancer.

A person born today is twice as likely to develop malignant melanoma compared to someone born only a decade ago
and 12 times more likely as someone born 50 years ago.

Being sun safe is the first step to reduce the chances of getting skin cancer later in life.

Teach Children Sun Safe Habits

Children learn healthy habits best at a young age. Therefore, it is important to begin protecting your children from
the beginning and teach them the importance of sun safety. With sun damage accumulating over a person’s lifespan,
beginning sun safety habits at a young age should be a priority.

What are ticks?
Ticks are bugs that feed on the blood of mammals, birds, and reptiles. Deer ticks and dog ticks are found throughout Massachusetts and may spread different disease-causing germs when they bite. Ticks are generally found in grassy, brushy, or wooded areas. Ticks do not fly or jump. They attach to animals or people that come into direct contact with them.Deer ticks: Both nymph (young) and adult deer ticks will bite humans. The highest risk of being bitten by a deer tick occurs throughout the spring, summer and fall seasons. However, adult deer ticks can also be out searching for a host any time winter temperatures are above freezing. Deer tick nymphs are the size of a poppy seed and deer tick adults are the size of a sesame seed.Dog ticks: In general, only the adult dog tick will bite humans. The highest risk of being bitten by a dog tick occurs during the spring and summer seasons. Adult dog ticks are about the size of a watermelon seed.

How can I protect my family from tick bites?

The single most important thing you can do is check yourself for ticks once a day. Favorite places ticks like to go on the body include areas between the toes, back of the knees, groin, armpits, neck, along the hairline, and behind the ears. Remember to check your children and pets, too. Remove any attached tick as soon as possible.

Use repellents that contain DEET on exposed skin and those that contain permethrin on clothing. Be sure to read product labels to ensure safe and proper usage.

Stick to main pathways and the center of trails when hiking.

Wear long-sleeved, light colored shirts and long pants tucked into socks. This will keep ticks away from your skin and make it easier to spot a tick on your clothing.

Talk to your veterinarian about the best ways to protect your pets from ticks.

There is currently no human vaccine available to protect against Lyme disease or any other tickborne disease found in Massachusetts.

What should I do if I find a tick on myself or my child?
The tick should be carefully removed as soon as possible. The longer an infected tick remains attached to a person or animal, the higher the likelihood of disease transmission. Use fine point tweezers to grip the mouthparts of the tick as close to the skin as possible. The tick should not be squeezed or twisted, but pulled straight outward with steady, gentle pressure. You should not apply kerosene, petroleum jelly, nail polish, or a hot match tip to remove the tick; these measures are not effective and may result in injury. Notify your health care provider if you have been bitten by a deer tick, or if you develop a rash or other flu-like symptoms following a tick bite.